This invention relates to the art of systems for recovery of physiological fluids, such as blood. In the preferred embodiment, the invention relates to a system for collection of blood during surgery and for returning the collected blood to the patient.
Systems for collection of blood during surgery for the purpose of returning the blood to the patient are known. These systems typically are vacuum systems that rely on sources of low pressure existing in the hospitals to create the suction required for collecting the blood. The collected blood may be washed by any of several known cell washing devices prior to providing the collected blood back to the patient.
Because blood cells are very fragile, they are frequently damaged during the collection process, which makes them unavailable for return to the patient. For example, cells will be damaged if subjected to excessive physical contact, such as turbulence or compression. For example, collection systems that use roller pumps cause excessive physical damage. Similarly cells subjected to pressure differentials that are too great will be damaged. Thus, blood cells subjected during vacuuming operations to exterior pressures that are too low will burst and not be available for return to the patient.
Although the use of vacuum is well known in the art, conventional systems use high vacuum (in excess of 250 mmHg), which is throttled by simple mechanical regulators. These systems do not employ a xe2x80x9cfeed-back loopxe2x80x9d or other sensing circuits to monitor vacuum parameters. Such systems are not optimal for collecting shed blood and are known to cause significant damage to collected red cells.
Mechanically regulating vacuum to xe2x88x92100-150 mmHg(dead end) can reduce the red cell damage greatly, but significant red cell damage occurs nevertheless and the problem is compounded by lack of understanding by the user of correct adjustment technique.
Systems that rely on the source of vacuum pressure typically used in hospitals frequently subject the cells to very low pressures, which severely damages the cells. Standard surgical suckers have an opening at the tip of about 0.125 to 0.150 inch, and the standard surgical suction tubing is usually 0.25 inch, (inside diameter), but may be as large as 0.281 inch (inside diameter). The connections between these components or to a standard collection chamber may incorporate substantial changes in diameter and possibly have reduced diameters at the connection points. The vacuum levels for suction collection of shed blood for return to a patient are recommended in the prior art (Autotransfusion Standards, American Association of Blood Banks) to be in the range of from xe2x88x92100 mmHg to xe2x88x92150 mmHg. This standard assumes the use of the above standard sucker and suction tubing.
Thus, there is a need for methods and apparatus that rapidly collect shed blood in surgery and trauma and do not damage the blood during collection. A need also exists for systems that safely collect shed blood that has formed into small, shallow pools in the surgical site, a process known as xe2x80x9cskimming.xe2x80x9d A further need exists for a suction (vacuum) system that does not exert large pressures on tissues in the surgical area while the blood is collected. Such systems are known as atraumatic systems.
Although portable suction devices for various application are known in the art, there has never been a blood collection system with all parameters optimized which can collect blood at high flow rates, allow skimming, and not subject cells and tissues to trauma.
In accordance with the invention a portable, electrically-powered blood collection system collects blood substantially without damage to the blood cells. The collected fluids are filtered and placed in a flexible bag to facilitate their return to the patient. The system is self-contained and requires only external electric power in one version and no external power in a second version. Minimal damage to the collected blood is obtained by optimization of the physical characteristics of the system. Further, the system conditions the collected blood and maintains it in a safe condition until a volume has been collected that is sufficient to warrant returning the blood to the patient. The system immediately and effectively packages the collected blood for convenient return to the patient by conventional IV administration techniques.
The blood collection system of the invention uses an electronically-controlled pump to create a low pressure flow of air to aspirate shed blood. An electronic circuit increases and decreases the vacuum parameters, such as pressure and flow rate, according to need, by sensing no load, low load and high load situations. Under a no load condition, e.g., air flow only, and a low load condition, e.g., surface suctioning air mixed with mostly foam, the system maintains a very low vacuum of about 20 mmHg and a correspondingly small rate of air flow. Under high load conditions, e.g., where the tip of the aspiration tool is immersed in a pool of blood or is occluded, the system instantaneously increases the vacuum to about xe2x88x92100 mmHg. Because the flow in the high load condition is almost all liquid, the flow velocity through the aspiration path is low (Poiselle-Hagen Law). In this system, the blood being collected is never exposed to the high vacuum or velocity that would damage the cells, and laboratory testing using these control parameters has shown insignificant levels of blood damage.
The collection/suction tube of the invention preferably has a thin wall, whereby it is lightweight and easy to use. Because the vacuum level is controlled and small, however, there is little danger that the tube wall will collapse when the tip is occluded.
The system of the invention preferably includes a large-bore sucker, the opening at the tip having a diameter of between 0.285 and 0.500 inch. The bore of the sucker continues unreduced to its connection with the suction tubing, which has a nearly equal diameter, and the two components are connected by a coupler that provides an unrestricted, smooth transition between them. The large bore sucker and tubing are connected to a collection chamber equipped with an equally large bore fitting. A suitable coupler is employed to allow an unrestricted and smooth transition between the tubing and chamber fitting.
The sucker assembly described above is connected to a vacuum source capable of regulating the vacuum at very low levels. The preferred embodiment of the system regulates the vacuum between xe2x88x9210 mmHg and xe2x88x92100 mmHg. The particular level of the vacuum is based on the demand and is governed by feedback through the sucker, tubing and collection chamber to the vacuum source. The pressure differential across a mechanical resistor in the vacuum line is sensed by pressure transducers and resulting signals are fed to a suitable electronic regulating source, which, in turn, operates the vacuum source in a pulsed mode, alternating between on and off conditions as required to maintain the desired vacuum for the particular demand condition.
With an open suction line (carrying no liquid) the resistance across the mechanical resistor is minimal and the vacuum is reduced to the minimum level. During skimming, there is increased resistance through the tubing and across the mechanical resistor, so the vacuum is slightly increased. With the collection of some pooled liquid there will be further resistance, so the vacuum level will further increase proportionately. With full immersion of the sucker tip in liquid, the vacuum resistance through the system will be at a maximum level, and the vacuum will then be controlled to be the largest level of xe2x88x92100 mmHg.
A general observation of fluid mechanics is that the rate of fluid flow through a tube is a function of the 4th power of the radius of the tube. Thus, a slight increase in the internal diameter of a tube results in a significant increase in the flow rate, all other conditions being equal. Recognizing this relationship, the system of the invention utilizes larger bore tubing to permit lower operating vacuum levels, which minimizes damage to the collected blood and avoids tissue trauma. Increasing the tubing diameter in accordance with the invention more than compensates for the reduction in vacuum levels by providing a larger than expected flow rate for these vacuum levels. The low vacuum levels used by the system of the invention could not provide flow rates acceptable to surgeons with standard bore suckers. Thus, the combination of the large bore sucker, tubing and connectors with lower vacuum levels is important.
Because the tubing has a larger bore, fluid moves through the tube more slowly while still achieving the desired flow rate. This is advantageous because less damage is caused to slowly moving blood than to faster moving blood. Another advantage is that the less-restricted pathway of the large bore system significantly reduces the potential for clogging the tube with debris during the surgical procedure. There are two reasons for this. First, the increased diameter has the ability to pass more potentially-clogging particles and, second, the unrestricted path allows potentially clogging solids to pass all the way through to the collection chamber.
The low pressures of the system (i.e., the maximum of xe2x88x92100 mmHg) also reduces or eliminates trauma to tissues and also reduces the tendency of the suction to xe2x80x9cgrabxe2x80x9d the tissue, known as invagination.
Yet another advantage of the small negative pressures employed in the invention is that the tubing may be made of thinner, more flexible materials. Prior art suction tubing must be able to withstand up to xe2x88x92600 mmHg because it may encounter vacuum levels this high when connected to standard hospital suction systems. Standard suction tubing has an internal diameter (ID) of 0.250 inch and an outside diameter (OD) of 0.375 inch and is made of PVC having a Durometer value high enough to prevent collapse at the maximum vacuum. The tubing of the invention may use lighter, thinner walled tubing because the vacuum is controlled to have a maximum of xe2x88x92100 mmHg. In the preferred embodiment, the tubing has an ID of 0.300 inch and an OD of 0.380 inch. The thinner wall also makes the tubing more flexible; a highly desirable feature in surgery.
Another feature of the invention is its manner of treating the collected blood with anti-coagulant, a significant aspect of conditioning all collected blood. Anti-coagulation has conventionally been achieved by the addition of a solution containing chemicals (typically heparin or citrate) which inhibit the normal clotting reaction of the blood to air and foreign substances. The proper ratio must be achieved; enough must be added to prevent clotting while too much anti-coagulant makes it difficult or impossible for the body to metabolize and may cause negative side effects, such as cardiac instability.
In accordance with the invention, the anti-coagulant is pulled into the collection chamber by the vacuum in the collection chamber. The amount of anti-coagulant varies with the vacuum level. Thus, the invention uses the controlled vacuum feature to regulate anti-coagulant flow in proportion to the volume of blood being collected. Under no load or low load conditions, the flow rate of the anti-coagulant is very low (a drip). Under high load, the vacuum in the system increases and draws significantly more anti-coagulant into the collection chamber (a stream). A disc of porous plastic is employed as a type of xe2x80x9corifice platexe2x80x9d to amplify the effect of the pressure differentials between no/low/high demand conditions. Alternately, an elastomer disc with one or more slits through it may be used for the same purpose.
Since both air and blood are pulled into the system by vacuum, the air must be continuously separated from the blood and exhausted. The collected blood and anticoagulant are introduced tangentially into a largely cylindrical collection chamber where the air is separated and exhausted out the top of the collection chamber. The blood/anti-coagulant mixture is filtered and accumulates in the bottom of the collection chamber.
Once sufficient volume has been collected for re-infusion, the blood/anti-coagulant mixture is pumped, preferably by a roller pump, to a re-infusion bag with an integral filter. xe2x80x9cSufficient volumexe2x80x9d depends on the patient and nature of the case and is typically about 200-600 ml. The design and speed of the roller pump/pump tube combination is such that blood damage is very small. Also, the roller pump is operated independently of the vacuum, which allows the bags to be filled while the vacuum is simultaneously operated.
The mixture of collected blood and anti-coagulant is pumped into a re-infusion bag with a built in 40 micron filter. The blood is pumped to the bag through a tube from the collection chamber. The tube is attached to the chamber through Luer locks, which are known in the art, to provide easy disconnection of the bag. After the filter bag inlet is clamped and disconnected, it is hung on an IV pole and the contents re-infused using conventional IV administration techniques. All of the blood/anti-coagulant mixture administered to the patient in this way passes through the 40 micron filter.
All vacuum blood collection systems require some method of preventing overflow of blood into the vacuum source in the event of a full collection chamber. The invention uses two systems; an electronic primary and mechanical back-up.
The level of blood/anti-coagulant mixture is sensed opto-electronically. Capacitance, ultrasound or other level sensing means well known in the art could be used alternately. The electronic circuit terminates operation of the vacuum pump at a predetermined level of blood, thus generally preventing overflow of the liquid into the vacuum system. Additional levels may be sensed to provide useful signals, such as nearly full, or nearly empty, etc., which may be employed to activate the roller pump to discharge the collection chamber or to warn an operator by auditory or visual signals.
A mechanical back-up feature is provided to prevent damage to the electric vacuum pump and other parts of the hardware in the event of failure of the electronic level sensing. A fluid stop, which is preferably a cylinder of porous plastic having a self sealing feature, such as application of self sealing Porex, is interposed between the collection chamber vacuum port and the air tube leading to the electric vacuum pump inlet. Fluid entering the fluid stop will activate the self sealing property of the material to effectively prevent flow of air or liquid, thus preventing further overflow. Once the level in the collection chamber is reduced, a new fluid stop must be installed to return the system to normal operation.
As collected fluid is pumped into bags, the weight or volume pumped is accumulated by an electronic circuit. A display indicates the weight or volume of a first bag when it is removed. Then, when the second bag is filled and removed, the display shows the weight or volume of both bags, and so on. Thus, the operator may easily determine the total amount of blood pumped to the bags for re-infusion.
Because the air flowing through the device was initially mixed with blood, it must be considered a biological hazard. The hardware unit of the invention is equipped with an easily changed exhaust filter that removes any airborne particulates. The user simply changes this filter periodically.